ANXIETY ATTACK

Anxiety is an emotion and that is normal in human beings. But it is termed as Anxiety disorder if the fear/anxiety is excess in relation to the situation and affects one’s day to day daily activities such as sleeping, eating, working, etc.

Anxiety disorder is not known to affect about 30% of population at some point in their lives. Everyone has their ups and downs, high and lows in life due to the circumstances of life, various incidents, etc. but people with anxiety disorder try to avoid situations or triggers that worsen their symptoms. 

The criteria for one to be diagnosed with Anxiety disorder are

  • The fear/anxiety is out of proportion to the situation. 
  • The symptoms affect the normal function causing disturbances in personal life, work and daily activities. 

Types

 

  • Generalized anxiety disorder : It involves persistent and excessive worry and fear about everyday activity causing symptoms such as easy fatigue, difficulty in sleeping and concentration, muscle tension, dizziness, difficulty in breathing, etc. 

 

  • Panic disorder : Panic attacks are usually recurrent. The symptoms are sudden and a combination of psychological and physical distress. One may feel they have a heart attack often. 
  • Phobia : Excess fear to specific object, situation, activity, that is normally not harmful. It is extremely difficult for the individual to overcome the fear and one may try to avoid it any cost. Examples are fear of heights, fear of spiders, fear of escalators, etc.
  • Agoraphobia : Fear of certain situations such as being in open places, outside of home alone, use of public transport, etc. One may always need a companion and may sometimes get severe to an extent that one refuses to leave the house, when left untreated.
  • Social anxiety disorder : One may have severe discomfort and fear of being in social situations or gatherings due to fear of being embarrassed, humiliated, looked down, etc. There may try to avoid social gatherings, meet new people, eat/drink in public, etc. and may affect daily activities and work life.
  • Separation anxiety disorder : This is most commonly seen in children but may extend to adulthood as well with a fear of separation from loved ones or those to whom he/she is attached. 

 

 

Risk factors

Specific causes of anxiety disorder are unknown but a few risk factors can be genetic, hereditary, environmental, psychological, traumatic events, developmental. 

  • A few personality traits such as pessimism, low self esteem, lack of self confidence, being too dependent on others, etc.
  • Emotional, physical, sexual abuse, etc.
  • Traumatic events in life such as relationship problems, divorce, change in job/location, loss of a person, etc.
  • Associated mental health disorders such as anxiety disorder, post traumatic stress disorders, sleep and eating disorders, etc.

A few medical conditions, that are known to be associated with anxiety are

  • Heart disorders. 
  • Diabetes. 
  • Hyperthyroidism. 
  • Alcohol, recreational drug intake or addiction, withdrawal.
  • Withdrawal from a few medications. 
  • Respiratory disorders such as COPD, asthma, etc.

Symptoms

Symptoms can be psychological or physical or a combination of both. 

A few psychological symptoms are

  • Restlessness, sense of dread and fear.
  • Difficulty in thinking clearly, focus and concentration.
  • Irritability.
  • Urge to avoid situations, events, that trigger anxiety.

A few physical symptoms are

  • Dizziness. 
  • Bodyache, tiredness, restlessness, muscle ache.
  • Excessive sweating. 
  • Rapid breathing.
  • Palpitations (elevated heart rate causing pounding heart).
  • Shaking.
  • Dry mouth, excessive sweating.
  • Pain abdomen, constipation. 
  • Headache, pins and needles sensation.
  • Social isolation. 
  • Excessive use of alcohol, drugs, etc. 
  • Insomnia with difficulty in initiating and staying asleep.

All symptoms may not be experienced by all individuals with anxiety but a few symptoms may be related by many individuals. The severity and duration of symptoms may vary between people, based on the cause/risk factor, etc.

Management 

Diagnosis is made by a psychiatrist or a psychologist after talking for some time to know about one’s feelings, attitude, behavior, approach to life, history of physical or emotional traumatic events, etc. to estimate probable underlying cause. Tests such as a hemogram, thyroid tests, ECG, etc. may be done to rule out an underlying medical condition. 

A mental health assessment is done and diagnosis may be made with criteria from DSM-5 (Diagnostic and Statistical Manual for mental disorders).

Treatment

Anxiety is treatable and two main modes of treatment are psychotherapy and medications. 

  • Medications may help in treating anxiety, that is prescribed by the psychiatrist after a detailed mental health assessment, evaluation and grading type of anxiety. One may need to try different medications and doses sometimes to find the right fit of medication that helps with one’s symptoms best and with less side effects because it may vary between individuals. It may also typically take about 2-4 weeks for the medications to work effectively with symptoms such as sleep, concentration, etc. Medications are to be taken as per prescription and can be tapered off gradually by the psychiatrist, if it is decided to be stopped based on an evaluation. Medication should not be stopped abruptly or without informing the treating doctor because one may experience withdrawal symptoms. 
  • Psychotherapy or talk therapy or counseling may be done one-on-one or in a group to help address the symptoms and educate on how to tackle and approach issues better. Education on causes, ways to help get relief from symptoms, changes in lifestyle, etc. may be guided through. It includes cognitive behavioral therapy primarily.
  • Lifestyle changes with a healthy diet and sleep cycle, regular exercises, working around the ways to control emotions and deal life challenged better.
  • Other options can be deep breaths, yoga, meditation, laughter therapy, acupuncture, massage therapy, etc.
  • Support groups help in coping up better.

Complications

Anxiety when left untreated or unnoticed, discontinuation of prescribed medications or treatment may lead to complications, that worsens the lifestyle.

  • Alcohol and drug abuse.
  • Depression.
  • Social isolation.
  • Difficulty in sleeping.
  • Family conflicts, relationship issues, etc.

References:

https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders

https://www.apa.org/topics/anxiety/

https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

https://www.nhs.uk/conditions/generalised-anxiety-disorder/

https://adaa.org/understanding-anxiety

https://www.webmd.com/anxiety-panic/guide/anxiety-disorders#1

 Dr. Divya Teja Pasupuleti

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